Fatigue medications and best way to write an appeal
Posted 01 February 2011 - 02:07 PM
I was recently prescribed Nuvigil that really helps get me through some of my worst slumps. The problem is that the medication is not covered by my insurance for the treatment of chronic fatigue.
I have also read that adderall has been prescribed to some patients to help manage their fatigue.
Since nuvigil is not covered and it is very expensive ($300 for a month supply) I am trying to appeal the decision. If anyone has any advice on what to write in the letter that would also be appreciated.
Posted 01 February 2011 - 02:53 PM
I'm clueless as to what to write in your appeal. Perhaps your doctor should be helping with this? It is common for medications to be used off-label, meaning for a purpose other than what they are approved for, so hopefully this won't be the impossible dream.
Good luck on your appeal and let us know what you find out, okay?
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Posted 01 February 2011 - 05:35 PM
What has worked for me in these situations is a) demonstrating that whatever the medication is that my insurance does cover has been given a fair trial and hasn't worked and/or b ), that other medications are contra-indicated for one reason or another. Of course it helps if your doctor is on board and willing to write a brief letter. Once I needed to enlist my ophthalmologist to say such-and-such was counter-indicated because the known common side effect would worsen an eye condition I already had. Sometimes it just takes persistence and asking the insurance company the right question. I was advised by mine to ask for a 'peer review' in order to get my pulmonary hypertension medication approved ($6000 per month). The peer review approved it right away.
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Posted 01 February 2011 - 05:57 PM
This is something your provider needs to do. There are forms they should have in their office that deal with situations just like this. Typically, you have to demonstrate that one to two other drugs that are on their formulary, did not work for you. More often than not, if the provider is persistent, you'll get it approved. I have tried Adderall by the way, and it really helps. I take it on the off day when I really need it.
Posted 01 February 2011 - 08:13 PM
For my insurance company this is the LevelI review where they want to hear from me.
I found some sample letters online. I've been trying to find some studies but nothing much is there.
Just a lot of user experiences.
Posted 02 February 2011 - 03:07 PM
I have never read this sort of letter but in general I have found that detail and specifics of your special situation are needed. I can't see that you can actually "prove" anything to them scientifically but you can explain your personal reaction and need.
Good luck. Read their letter carefully and provide them with what they specifically ask. They usually have a set of rules they follow and they need you to supply the information required by those rules.
Posted 28 March 2011 - 02:00 PM
I followed your advice and noted everything I had tried to battle fatigue.
About 15 days from then I received my approval. Thanks for the advice.